An introduction on Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD) is an anxiety disorder that is characterized by excessive and difficult-to-control worry. Simply put, people with GAD spent a lot of time thinking about possible bad things that could happen in different situations.
- “I’m worried about whether I will make my appointment tomorrow”
- “I’m worried about my kids getting sick”
- “I’m worried about my finances and if I have enough money for this year”
- “I’m worried that I might get into an accident and can’t work”
As the name suggests, the fears in GAD are very generalized – worries can span across a number of different everyday topics, such as health, family, relationships, work, school, among many other things. The key aspect is that someone with GAD will spend a lot more time worrying (usually hours) than other people in the same situation and find it very difficult to put these worries away to focus on their daily tasks.
In order for a diagnosis of GAD, these worries must be accompanied by at least 2 of the following 6 symptoms:
- Feeling restless, keyed up; on-edge
- Fatigue (tired)
- Difficulty sleeping
- Difficulty concentrating
- Muscle tension
Dealing with Intolerance Of Uncertainty in Generalized Anxiety Disorder
There have been different proposed theories for how GAD develops and is maintained. Some view GAD as stemming from ‘fear of the unknown’, other theories posit that people with GAD have underlying beliefs about worry (e.g., “worrying is useful and helps me solve problems”).
Dugas and colleagues (1997) developed an idea that a key construct associated with GAD is an intolerance of uncertainty. Specifically, someone with low tolerance for uncertainty may find it hard to dissociate from a negative outcome even if there was a 1% or 0.1% chance of the feared outcome happening.
People with anxiety disorders are typically very aware that their fears are out of proportion with the situation. Oftentimes, I have heard in people with anxiety problems that “I know that the chance of something bad happening is really low. However, even if the chance of something bad happening is very unlikely, I can’t risk it”. Dealing with these thoughts is particularly challenging because nothing in life is guaranteed – there is always some risk in everything we do.
Therefore, if intolerance of uncertainty is a main contributor to anxiety, then the logical treatment is to improve our ability to deal with uncertainty. Below, I discuss a few ways we can support this goal.
1. Focusing on what’s important to us
One way to begin working towards dealing with uncertainty is to focus on our values – i.e., life-concepts that are important to us. That is, what is it that we are losing when we allow our uncertainty to govern our lives?
For instance, somebody who is unwilling to try new foods because they are not sure if it’ll taste good may be losing novel experiences and the opportunity to find something they may really like.
Another example might be somebody who decides to avoid social gatherings where they don’t know the people because they are uncertain if they’ll vibe with these individuals may lose out on potential great relationships and an enjoyable environment.
Consider to yourself: is there anything that I am losing out in life or that I would really enjoy if I didn’t let my intolerance of uncertainty affect me? These important things may be helpful to support you in trying something out in spite of possible negative outcomes.
2. Using behavioural experiments to increase tolerance to uncertainty
Behavioural experiments are a great way to tackle intolerance of uncertainty because they expose us to trying new situations and see if our feared prediction will come true. For example, there may be a worry that “if I try a new restaurant, I might not enjoy it”. By engaging in the activity as part of a behavioural experiment, we’ll get to see if that fear is true or not.
Perhaps more importantly, behavioural experiments allow us to learn whether we can cope with a negative outcome if it did happen.
For example, let’s say you did try out that new Greek restaurant and enjoyed the food less than you thought. How did you cope with it?
“Well, my partner and the kids enjoyed it more than me so they ate it. I ended up making something from the refrigerator”.
As you can see from this example, a behavioural experiment allows us to answer the question that anxiety tends to push you away from: And then what happens?
Typically, the answer to that question is not as catastrophic as our anxiety leads us to believe.
Here’s a post on behavioural experiments if you are interested in formally conducting one!
3. Supporting the use of behavioural experiments
Being a curious experimenter and conducting behavioural experiments is easier said than done. Therefore, it can be helpful to have strategies to support your use of behavioural experiments.
Relaxation strategies are a great way to support behavioural experiments because they may tune down our anxiety just enough to try out the experiments. These can include breathing exercises or guided relaxations. Consistent use of relaxation exercises is also a great way to reduce anxiety more generally.
If you’re not sure which experiment to try first, developing an exposure hierarchy can be a good way to find experiments that feel challenging, but manageable. As you continue to develop your tolerance, you can slowly build up to more difficult experiments!
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